BACKGROUND: Pial arteriovenous fistula is a rare disease and surgical treatment for these lesions is difficult. We present our clinical outcomes of endovascular treatment for intracranial pial arteriovenous fistula (AVF). METHODS: We reviewed the clinical and radiologic data of 16 patients with intracranial pial AVFs who were treated endovascularly at the Beijing Tiantan Hospital between 1998 and 2008. RESULTS: Six patients presented with intracranial hemorrhage, six presented with headaches, two with seizures, one with neurologic deficit, and one with transient ischemic attack. Cerebral angiograms showed that these pial AVFs were supplied by the middle cerebral artery (n = 6), the anterior cerebral artery (n = 4), the posterior cerebral artery (n = 3), the basilar artery (n = 2), and the inferoposterior cerebellar artery (n = 1). All AVFs were associated with large venous varices. One of the lesions had two associated feeding artery aneurysms. The venous drainage was deep in 11 lesions. All AVFs were embolized transarterially through the feeding arteries. Coils was used in 14 patients with a combination of liquid embolic agent (n-butyl cyanoacrylate and Onyx [Micro Therapeutics Inc., Irvine, CA]) in five patients; Onyx was used in three patients. Immediate complete angiographic obliteration was achieved in 13 patients. Three patients incompletely treated with coils showed complete obliteration at follow-up. Twelve patients experienced an angiographic and clinical cure without any complications at 3 months. Three patients (18.75%) experienced hydrocephalus after the procedure caused by venous thrombosis. Glasgow outcome scores were good in 15 patients (93.75%) and poor in 1 patient (6.2%) at follow-up. CONCLUSIONS: Transarterial embolization of the arterial feeders using coils and/or liquid embolic agents may be a good treatment for pial AVFs. Hydrocephalus caused by venous thrombosis is the main complication.